Dental Anxiety

Fear of the dentist and dental treatments can discourage people from getting the care they need. Dentists should encourage patients to be honest and share their concerns and then together they can establish methods to make the dental treatments as comfortable and stress-free as possible.

If someone has real dental anxiety what symptoms can they exhibit and how severe can they be?

Dr. Darren McKeever: Dental anxiety can be an amazing inhibitor for people to get the care that they need. The symptoms that they may show are oh they get sick before a visit and they have to call to cancel, or the symptomatology that they were having has completely disappeared when they get to the office because they’re really afraid of what the answer might be to why am I having trouble. It can be really severe and completely shut a patient down to the point where they don’t even want to share what’s happening with them. I’ve had people literally come into the office in discomfort and pain and sit there and cry and we’re thinking wow that’s amazing pain, but really what they’re crying about is they’re just so terrified to be in the chair. It’s something that we struggle with as a species, fear, because it’s a great inhibitor for getting healthy.

What are the most common aspects of a dental visit that people are most anxious about?

Dr. Darren McKeever: Well I really think it boils into a couple of things. One, obviously pain and discomfort. Nobody wants to be hurt. Now I can’t ever promise a patient that they’re not going to feel something, but I always promise them you’re going to be so well prepared if you’re going to feel something that you can handle it.

But it’s either pain and then the other side of the coin to that tends to be control. Some people because they’re so afraid of the potential for discomfort will try and exert so much control over the situation that they’re afraid if they relax on the control they’re immediately going to have pain. That’s another animal altogether because when people are feeling that, it’s almost like they’re influencing the outcome of the treatment because the dentist has to respond to that. Therefore, they may later put themselves right into the scenario where they are having discomfort because they’ve elected to modify treatment in one way or another, and it’s really in the long-term not in their best interest.

Some of the aspects of a dental visit that people are uncomfortable about, it’s either pain or are they going to be able to exert control to keep themselves in their comfort zone.

How important is it to sit down and speak to the dentist about your fears or concerns?

Dr. Darren McKeever: It’s critical. It’s absolutely critical because we can sort of figure out if somebody’s coming in and they’re anxious based on certain cues that they give us, but sometimes if they’re not willing to accept it, to admit it to themselves, and we say hey I think you might be a little anxious over this procedure, it can come across as insulting. I would never want to do that. But people need to be honest with themselves because I can’t help them if I don’t understand what their parameters might be on how comfortable they are in the chair.

I mean let’s face it, if you’re coming in for dental care, there’s a chance you’re going to have to get an injection to put a tooth temporarily numb or you’re going to really feel it. But if I don’t know that you’re someone who has a history of literally hitting the dentist when you get an injection, I should know that. Not because I’m worried about getting hit, but during the procedure if you move that could cause damage. So, people really, really just need to open up and develop that rapport with the dentist. We’re really here to help. We’re here to serve the patient. To serve the patient the best, we really have to understand what they’re feeling.

Do you have a particular strategy for helping your patients cope with their dental anxiety?

Dr. Darren McKeever: Absolutely. My opinion is as long as the patient feels that they have enough control during the procedure, up to a point, but they have enough control for them to feel comfortable, they tend to relax. My analogy that I give people is that you can respond to an issue in two different ways if you know you’re going to have the same issue, but on one end you’re not going to see it coming, it’s going to jump out of the dark, it’s going to do something to you without you being prepared, you’re going to have a much more dramatic and negative response than if you see it coming, you’re prepared for it, you face it head on. Whatever the same reaction is that you’re going to have, you’re going to be in control of it and it’s not going to be something as bad when it’s dealt with that way.

Some people we literally have to let them know up to a point you have all the control in the chair. I mean not to the point where I’m literally handing you the drill and you’re working the foot pedal drilling yourself, but you need to stop, you need to catch your breath, you feel like you’re drowning a little bit, we’re going to stop, we’re going to help, we’re going to deal with that issue, we’re going to make you feel comfortable, and then we’ll restart when you’re ready.

When we try and rush through and just get focused and tunnel vision on oh I have to drill the lower right bicuspid, that’s crazy. This is somebody’s mom maybe who’s in the chair, somebody’s sister, somebody’s dad. They’re not a bunch of white crashing rocks that molest food and then you swallow, who climb the stairs park the car and now they’re sitting in the chair. It’s a human being, it’s a person, and they need to be treated like that.

What are some other ways dentists can help patients overcome their dental anxiety?

Dr. Darren McKeever: Well if we can’t get through it with sort of, I guess a behavioral modification of letting them know that we’re here to help, then we have to go to the next levels of relaxation.

A lot of people ask about nitrous oxide, known as laughing gas. It can be a double edge sword. Sometimes people get a little too relaxed so that they get a little uncomfortable with how they feel.

Another step that can be done instead of that, although on this next one you really shouldn’t be allowed to drive, is there are oral medications that can be given for people to relax them. They don’t knock them out, but they relax them enough so that they can handle all the bumps and jumps that come along during the process because they just can’t feel like they can get enough control to feel comfortable in the chair.

Then unfortunately we have some people who may even have anxiety that’s so bad it becomes a physiologic problem, like they gag constantly just when they open their mouth, or they feel a little bit of water in the back of their throat and they can’t handle that, they have a panic disorder maybe. That’s where we have to consider an IV sedation scenario. You don’t want to have the inhibition of being able to get comfortable in the chair end up with a bad result in the dentistry. Who wants to have dentistry done more than once, nobody. So, if you’re going to do it, you want to make sure it’s successful the first time. Sometimes we actually literally have to bring in anesthesiologist into the office and we use IV sedation to get people comfortable, and that works out great.

Learn More

If you are interested in speaking with Dr. Darren McKeever, visit www.mckeeverdentalcare.comor call 973-839-8180 to schedule an appointment.